Search Results for: mississippi

Highlight on Mississippi: Mosquito-Borne Viruses Threaten the Delta State

Deadly and debilitating viruses are flying around Mississippi on the wings of mosquitos. Mississippi residents and the Mississippi State Department of Health (MSDH) are on watch this summer for the familiar West Nile virus (WNV) and a new, unlikely visitor: Chikungunya virus. Two cases of WNV and one case of Chikungunya virus have already been confirmed in Mississippi, and several other reports are still under investigation.

Chikungunya

Chikungunya virus, according to the Centers for Disease Control (CDC), usually occurs in Africa, Southern Europe, Southeast Asia, and islands in the Indian and Pacific Oceans. However, in 2013, the virus was found in Caribbean islands. Since then, the virus has been on the move as tourists carry the disease when they travel. Mississippi’s first report of the disease was confirmed after the virus was brought back by a Mississippi resident returning from Haiti. Like WNV, Chikungunya is spread from person to person by mosquitos. The usual suspect is known as the Aedes mosquito. However, the MSDH says native Mississippi mosquitos can transmit the virus.

Symptoms

Symptoms begin 3-7 days after a bite from an infected mosquito, according to a CDC fact sheet. The most common symptoms are severe joint pain, which is often localized in the hands and feet. Symptoms may also include headache, muscle pain, joint swelling, or rash. Once symptoms start, patients usually feel better within a week; however, some infected patients experience long term joint pain. Unlike WNV, Chikungunya is not usually deadly. However, because there is no anti-viral treatment, the best medicine is still prevention.

Prevention

Preventing exposure to any mosquito-borne virus means limiting exposure to mosquitos. The CDC recommends window screens, mosquito repellants, long sleeves, and the emptying of standing water whenever possible. The MSDH adds additional recommendations by suggesting that mosquito repellants contain DEET, that clothes are lightly colored, and that Mississippi residents avoid areas where mosquitos are prevalent during the day, when the mosquitos that carry the virus are most active. When it comes to the Chikungunya virus, preventing exposure to mosquitos, when visiting the Caribbean, is even more important. The MSDH places special emphasis on the obligation of those going out of the country to be cautious in areas where the virus is prevalent. Additionally, the MSDH advises that individuals who suspect they may be infected with Chikungunya remain indoors for at least 10 days, so that the virus cannot be spread by local mosquitos to other residents.

West Nile Virus

Unfortunately, Chikungunya is not the only hazard. West Nile Virus has been a longstanding threat to Mississippi residents. In 2013, the MSDH reported 45 cases of WNV and five related deaths. This summer, the MSDH has already reported two cases. The MSDH says WNV symptoms usually are mild and “may include fever, headache, nausea, vomiting, a rash, muscle weakness or swollen lymph nodes.” However, in some cases, WNV can lead to severe encephalitis or meningitis infections, which can cause paralysis and death. Mississippi has other mosquito-borne viruses its residents must be cautious about as well, including: La Crosse encephalitis, St. Louis encephalitis, and Eastern Equine encephalitis. The prevention advice for Chikungunya applies to any of the other viruses carried by mosquitos.

Looking Ahead

It is hoped that the CDC and MSDH will be able to convey their message about mosquito bite prevention. With any luck, the Mississippi case of Chikungunya will be an isolated occurrence and the neighboring states won’t have to ask the question: how far will it spread?

 

Mississippi Rejects Medicaid Expansion: Wise Move for America’s Least Healthy State?

For the tenth year in a row, Mississippi has placed last in America’s Health Rankings, an annual report issued by United Health Foundation. With an increasing portion of the state’s population (19.2 percent) lacking any type health insurance coverage and a 21.3 percent poverty rate, also making it the poorest state in the union, Mississippi appeared to many as the state that would benefit most from extra federal funding for its Medicaid program; however, Governor Phil Bryant vehemently disagrees.

In his October 1, 2012 editorial in the Washington Post, Governor Bryant declared that he would fight against any efforts to expand the state’s Medicaid program. His stance makes Mississippi the sixth state in the Union, in addition to FL, GA, LA, SC, and TX, to officially reject Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148). Some critics believe that these states, all led by Republican governors, are merely politically posturing for the upcoming November elections, in which PPACA repeal is a popular stance of Republican candidates.

Those in support of the expansion cite Mississippi’s population, poor in both health and finances, as a key example of why the Medicaid expansion is essential to health reform. They criticize the governor for turning down “free money” from the federal government that would allow the state to raise the ceiling for income eligibility for the program, with the federal government paying 100 percent of the expansion cost until 2017, when the state would be required to cover 10 percent of the bill. It is estimated that Mississippi could subsequently provide coverage for 400,000 additional residents. Hospitals have also voiced concern that refusing the expansion will stick them with unpaid medical bills of uninsured persons they are required by law to treat.

Governor Bryant is quick to caution his critics that free money is not truly free. He stated, “People tend to forget that government has no dollar that it has not gained through taxation or borrowing” and cautioned readers that in order to pay for health care reform, the federal government was “raiding funding from other programs and levying taxes against the American people.” He warned his residents that in order to even come up with the 10 percent contribution toward Medicaid expansion, Mississippi would have to divert funding away from education, public safety, and the creation of jobs in the states–all higher priorities than feeding a program that would be growing out-of-control to cover one of every three Mississippi residents.

The governor emphasized the importance of personal responsibility among the state’s residents to choose lifestyles that include exercise and healthy food choices and do not include smoking and teen pregnancy–choices that contribute to the state’s epidemic health problems. They main objective for state government, he said, was to provide a climate where business is successful, creating jobs for residents who can then obtain their own health insurance on the private market.

Kusserow on Compliance: HIPAA enforcement update

At the 2018 HCCA Compliance Institute HIPAA Policy and Enforcement Update, it was reported that since September 2009 through the end of 2017 there were 2178 reports filed with the HHS OCR involving breaches affecting 500 or more individuals. In addition to large breaches, there were over 300,000 reports of breaches of protected health information (PHI) affecting fewer than 500 individuals. Individuals affected by the large breaches were about 177 million. So far, OCR’s website has posted 38 breaches as of April 2018. In all, nearly one million patients may have had their PHI put at risk by these incidents with the number continuing to grow. The breakdown of type of large breaches includes:

  • Loss/Theft continues as the most often reported problem; nearly half of the cases.
  • Laptops and other portable storage devices represented one fourth of large breaches.
  • Hacking/IT Incidents account for about one in five reported incidents.
  • Paper records accounted for another fifth of the large breaches

10 largest 2018 incidents to date by number of patient records affected

  1. 582,174 – California Department of Developmental Services, 4/06/2018, Unauthorized Access/Disclosure Incident
  2. 279,865 – Oklahoma State University Center for Health Sciences, 1/05/2018, Hacking Incident
  3. 134,512 – St. Peter’s Ambulatory Surgery Center LLC- d/b/a St. Peter’s Surgery & Endoscopy Center, 2/28/2018, Hacking Incident
  4. 70,320 – Tufts Associated Health Maintenance Organization, Inc. reported on 2/16/2018 an Unauthorized Access/Disclosure Incident
  5. 63,551 – Middletown Medical P.C.,  3/29/201 an Unauthorized Access/Disclosure
  6. 53,173 – Onco360 and CareMed Specialty Pharmacy, 1/12/2018, Hacking Incident
  7. 36,305 – Triple-S Advantage, Inc., 2/02/2018, Unauthorized Access/Disclosure Incident
  8. 35,136 – ATI Holdings, LLC and its subsidiaries, 3/12/2018, Hacking Incident
  9. 34,637 – City of Houston Medical Plan reported on 3/22/2018 a Theft of Laptop Incident
  10. 30,799 – Mississippi State Department of Health, 3/26/2018, Unauthorized Access/Disclosure

Top 10 Recurring Compliance Issues

  1. Pattern of disclosure with sensitive paper PHI
  2. Business Associate Agreements
  3. Risk analysis issues
  4. Failure to manage identified risk, e.g. Encryption of data
  5. Lack of transmission security
  6. Lack of appropriate auditing
  7. No patching of software
  8. Insider threats from employees and contactors
  9. Improper disposal of data
  10. Insufficient data backup and contingency planning

HHS OCR calls for health care organizations to establish contingency plans to keep patient data secure and mandate that covered entities and business associates have such plans. In their March newsletter, OCR officials urged health care organizations to figure out which IT systems are critical, to understand how to function in a disaster, and to back up PHI so it can be retrieved if the original data are lost or taken offline. Once developed, the plan should be routinely tested to identify gaps and ensure updates for plan effectiveness and increase organizational awareness. The plan should be reviewed and updated on a regular basis when there are changes: technical, operational, or in personnel.

 

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2018 Strategic Management Services, LLC. Published with permission.

Fraudulent claims submitted to TRICARE for unnecessary medications ends in guilty pleas

In related cases, a pharmacist and pharmacy marketeer, both of Mississippi, pled guilty to conspiracy to commit health care fraud in a scheme that defrauded TRICARE, according to a July 25, 2017, announcement by the Department of Justice (DOJ). The pharmacist and his co-conspirators received at least $192 million in payments for medically unnecessary medications from TRICARE and private insurance companies. In the case of the pharmacy marketeer, TRICARE made payments of approximately $2.3 million for false and fraudulent claims submitted by the pharmacy. Sentencing hearings are scheduled for October 17, 2017.

The pharmacist’s role

The pharmacist pleaded guilty to one count of conspiracy to commit health care fraud and money laundering for dispensing medically unnecessary compounded medications and causing fraudulent claims to be submitted to TRICARE. Plea documents revealed that the pharmacist admitted that he (1) conspired with others to select compounded medication formulas based on profitability rather than on effectiveness or patient need, and (2) conspired with the pharmacy co-owners to avoid fraud prevention measures, such as collecting copayments, to incentivize patients to receive medically unnecessary medications.

The marketeer’s role

The pharmacy marketeer pleaded guilty to one count of conspiracy to commit health care fraud for his role in the scheme to defraud TRICARE. Plea documents indicated that the marketeer admitted to (1) soliciting physicians and other medical professionals to write prescriptions without seeing patients for medically unnecessary compounded medications dispensed by the pharmacy; and (2) conspiring with others to falsify patient records to make it appear as though medical professionals had seen patients prior to the date prescriptions were written.